Complications of Sinus Surgery

Joseph Han, MD
Jay Dutton, MD

Introduction
Surgery of the septum, turbinate, and sinuses is recommended only after medical management has failed and further intervention is required.  Even though surgical treatment is effective the procedures are not without risk.  Patients must be aware of these risks before electing to proceed and weigh the benefits of the procedure against the risks involved.  If you are concerned about these or other risks of the proposed surgery, please ask your surgeon.  
These risks include but are not necessarily limited to, the following:

Complications of nasal (septum and turbinate) surgery

  1. Bleeding after the operation: It is normal to have some bleeding after septal and turbinate surgery and fortunately it rarely requires additional intervention.  Aspirin, ibuprofen, and certain non-prescription supplements such as vitamin E and ginko can increase the risk of bleeding, so patients should consult with their physicians before using these medicines before or after surgery. Postoperative bleeding most often occurs within the first 24 hours of the procedure.  If the bleeding causes a hematoma (blood clot) within the septum, removal of the hematoma is necessary.
  2. Brain fluid leakage: The floor of the brain is where the septum attaches to the roof of the nose.  If this thin bony layer is fractured, brain fluid can leak into the nose.  This is often quickly identified and repaired in the operating room.
  3. Impaired sense of taste or smell: The sense of smell usually improves after the procedure, although it may occasionally worsen, depending on the extent of swelling, infection, or allergy.  This impairment is often temporary but can be prolonged.
  4. Nasal obstruction: Much of the nasal septum is made of cartilage, which has "memory" - the propensity to move back to its original position.  Although preventative measures are performed by the surgeon at the time of procedure, the cartilage may move after the surgery which may rarely lead to persistant blockage.  Small scar bands may also occur in the nose and require removal by the surgeon at postoperative visits.
  5. Numbness: A temporary numbness of the front upper teeth, lip or nose may occur after surgery but is usually self-limiting and do not require further treatment.

COMPLICATIONS OF SINUS SURGERY
  1. Bleeding after the operation:  It is normal to have some bleeding after  sinus surgery and fortunately it rarely requires additional intervention.   Aspirin, ibuprofen, and certain non-prescription supplements such as vitamin E and ginko can increase the risk of bleeding, so patients should consult with their physicians before using these medicines before or after surgery.  Postoperative bleeding most often occurs within the first 24 hours of the procedure although it is normal to have bloody drainage for several days.
  2. Intracranial complications (injury to the brain): The thin bony floor of the skull forms the roof of the frontal, ethmoid, and sphenoid sinuses.  If this layer is fractured or entered, brain fluid leakage may occur. Brain fluid leakage can be easily identified and repaired in during the procedure.  After the repair, nasal packing and a short hospital stay may be needed.  Rarely, this may not be immediately apparent requiring an additional intervention at a later date.  In extremely rare circumstances, infection of tissue surrounding the brain (meningitis) and bleeding into the brain cavity may occur.
  3. Intraorbital complications (damage to the eye or surrounding tissue): The eye is situated adjacent to several of the paranasal sinuses and is separated from them by a thin layer of bone.  Because of the close proximity, in rare cases, bleeding may occur into the orbit requiring treatment at the time of the initial surgery. Visual loss and blindness have been reported but are extremely rare.  Another very uncommon problem is damage to the muscles that move the eye which can lead to double vision (diplopia).  In certain circumstances, there may be a change in the function of the tear ducts causing excessive tearing.
  4. Impaired sense of taste or smell: The sense of smell usually improves, although it may occasionally worsen, depending on the extent of infection, allergy or polyps. It is not uncommon to have a temporary impairment in smell/taste after sinus surgery which in rare cases can be prolonged.  If you have a decreased sense of smell or taste before surgery this may or may not improve with surgical intervention.
  5. Voice changes: One of the functions of the sinuses is to affect resonance, so vocal professionals should be aware of potential changes in their voice after sinus surgery.
  6. Infection: The most common reason to undergo sinus surgery is chronic sinusitisthat does not resolve with medications.  The patient with sinusitis is therefore at risk of developing certain other infections in this area (abscesses, meningitis, etc.) regardless of whether they manage the sinusitis with or without surgery.
  7. Nasal obstruction and pain: Scar bands and crusting may also occur in the nose and sinus after the operation During the postoperative visits the scar tissue and crusting are removed to relieve the obstruction and pain.
While sinus and septal surgery has risks, often not intervening does as well. When left untreated, some sinus infections may rarely spread to adjacent structures such as the eye or brain and lead to abscesses in these areas, meningitis, visual loss, or even death.


Revised 6/2011
©American Rhinologic Society